Monthly Archives: February 2014

Yesterday I had the pleasure of seeing my therapist. Yes, you heard me right: I am a therapist with a therapist. Now, I hope you’re not expecting a rundown of the session; I do have some boundaries.

I’m first to admit that at times I haven’t coped very well because of my health challenges. I see a very patient, caring, and supportive woman who has seen me through my medical ups and downs. I honestly don’t know what I would have done without her.

J. knows it helps me to see my therapist and, if I am struggling (okay, if I’m being unusually cranky), she gently asks me when my next appointment is. It’s sometimes harder for me than for J. to notice I’m not coping well, so invariably I make the call.

I see this lovely woman less often than I used to. I worry about boring her with the same stories, the mundane details, and the unrelenting ups and downs that are the nature of any chronic illness. My own clients have expressed similar worries over the years. Despite these concerns, my therapist makes me feel that she enjoys seeing me and is kind enough to allow me to rebook on an as-needed basis.

One of the hardest things about therapy is that our therapists can’t resolve for us the problems we bring them; we still have to muddle through ourselves. “What’s the point in talking about my divorce/dad’s death/rotten kids/health problem if my therapist can’t fix it?”, you might wonder. In my case, maybe my therapist can’t cure my leukemia, but she can help me to live with my illness with more acceptance and less fear, and that she most certainly has.

I’ve questioned whether, as a psychologist, I should be able to deal with these issues on my own. I know many people, psychologists included, who would never consider seeking help for themselves. I don’t think any of us should be ashamed of needing support through tough times. And honestly, how could I do what I do if I didn’t believe in the value of counselling?

Psychologists are human, I am first to admit, and we have challenges that sometimes we just can’t seem to overcome on our own. If you think I’m trying to justify my own need for help, you’re probably right, and you’re welcome to tell me so. But deep down I truly believe I’m allowed to be as vulnerable as you. I too get stuck sometimes and need help getting unstuck. Also, I want to ensure I’m dealing with my own issues effectively so they don’t interfere with my work with my clients. I’ve also learned a lot from my experiences in counselling about how to approach my own clients. I wonder whether being a client has helped me to be a better therapist.

I’ve booked another session in just over a month. Do let me know if you think I should move that appointment up. I imagine you’ll be able to tell.

Last night a dear friend dropped by with these beautiful tulips. Initially, I thought she had brought them because I had been fawning over her three vases of fresh flowers the previous weekend. But then she congratulated me on my news for the day. Let me explain.

Since the millennium, when others were worried about clocks stopping, I was diagnosed with an ugly blood clot outside my liver that impairs its functioning. Hence the blood thinners and diuretics and two more of my daily medications. (Cancer is really the least of my worries.) Every year or two my devoted and adored liver specialist peeks inside me to make sure everything looks okay. Yesterday morning I underwent this long-scheduled procedure at the hospital.

You should know that I love going for this procedure. For someone who is chronically exhausted, there is nothing better than an excuse to sleep soundly for a good 15 minutes during the day, and the mild sedation ensures that. The sedation also helps me forget the inane things I say as I’m waking up afterward, like the time I told the doctor how handsome he was. (I was just stating a fact.)

But if you recall, a few weeks ago, I learned I was anemic. I hadn’t mentioned that my cancer team was worried I might have an infection. We were hoping yesterday’s procedure might provide some insight on the source of the bleed.

So when the doctor caught J. in the hall immediately following the procedure–I was still sleeping like a baby at the time–he said: “I’ve got great news!” He went on to tell J. that I had multiple stomach ulcers. ( I could post the pictures but I thought the tulips were much prettier.) And we all know that ulcers can bleed.

Now, why is that good news? Because there are a lot worse, and less easily treatable, reasons for blood loss. Most ulcers are a result of infection and are easily cleared with antibiotics. Within a week, I will know whether that is the case with mine. If I get anemic again once the ulcers are treated further investigation may be warranted, but most likely I’ll be fine. If the specialist thinks multiple ulcers are great news, why shouldn’t I?

As an aside, updated testing also revealed that those two pints of donated blood I was blessed with a few weeks ago have done their job. I may not yet have as many red blood cells as you, but I’m back to my usual below-normal range. Yes, everything is moving in the right direction.

My friend clearly understood that, even though the doctor revealed a problem, we had reason to celebrate. As she noted, she had never before congratulated someone for having ulcers. Now I have lovely tulips that will hopefully grace our counter for the week as I await further instruction. Everything is going to be fine.

I’ve always loved school. Call me a brown noser or keener or whatever you like, but I love investigating and learning and understanding new things. I spent too many years at university because I loved being on campus and amongst peers who were keen to learn, and I loved teachers who were excited to share what they knew. From elementary school through university, I even worked part-time in libraries, which makes me the ultimate nerd.

As an adult, my love of learning has not abated. I have taken continuing education courses of all kinds over the years, and have gone to conferences just for fun. I surf the internet not to escape reality but to know more. I am far from the best chef, for example, but I sure know a lot about cooking techniques, ingredients, and other cultures’ foods.

So imagine my delight when, upon being diagnosed with leukemia last year, I discovered a whole new world of learning opportunities out there. I have dubbed these opportunities “Cancer School”. And no, I don’t mean internet health research. That’s a minefield I avoid, choosing instead to save my questions for my brilliant cancer specialist whom I have trusted with my life since she saved it not too long ago.

One of the best things about Cancer School is that you don’t have to talk to your classmates about your illness because it’s just understood. Initially I feared hanging out with cancer survivors would be a downer, but I’ve realized the opposite is true. My classmates may be bald or pale or rail thin, but they’re living with an illness, just like me. They are often funny or engaging or smart, or sometimes they are deathly dull and painful to talk to just like me (and many others without cancer). And, like me, they may want to forget about cancer for the afternoon. I can share a lovely day with an amiable group and learn something that may improve my quality of life.

Cancer School offers free classes of all sorts. I have attended lectures on managing fatigue, on eating well with cancer, and on returning to work. I could learn to apply makeup to mask the effects of my illness, but I’ve never worn makeup so why start now?

The cooking classes, held in a space donated by the local high-end cooking school, are my favourites. Fellow cancer club members and I make ourselves a healthy, immune-supportive meal that we get to enjoy together at the end. But I feel bad about the day I showed up to one of these classes not realizing I had just dripped my raspberry smoothie all the way down my shirt. Unfortunately, the stain looked remarkably blood like. How could no one have told me? In retrospect, I can’t believe my classmates gagged down what I had helped cook that day. Upon arriving home, I realized to my horror that I looked like I’d hemorraghed all over myself. I’m so sorry, cooking-school classmates, and no hard feelings if you pick another chopping partner at the next class.

I’m celebrating a special anniversary this month: I’ve officially been a psychologist for 20 years. But I’ve been working only occasionally since leukemia hospitalized me 18 months ago. I still pay my professional dues, but lately I’ve worked just enough to cover basic work expenses. Can I still consider myself a psychologist if I’m not working?

I really just happened into psychology, but it turns out I like the work, although it’s not without its stresses. I’ve often felt good about what I do, and I’m happy if I can help a client feel better.

I was very distressed about abandoning clients so abruptly when I was hospitalized, and long feared I may have upset them with my unexpected disappearing act. Don’t get me wrong: I know another psychologist could well assume these clients’ care, yet I had developed relationships and wanted to see clients through. It never occurred to me that I wouldn’t be there to do so, and I deeply regretted not having planned for that possibility.

I still wonder how my former clients are doing, but psychology guidelines forbid my calling to find out. When old clients make contact, I’m thrilled to be able to catch up on their lives. About six months ago, I decided I was up to seeing one of these clients. I didn’t sleep much the night before this first post-cancer session since I feared messing up. I warned this client that I might be a bit rusty but, to my relief, she chose to return. Counselling must be one of those skills that, with enough practice, practitioners don’t lose after a short break.

Since then, I have been able to sleep the night before those occasional client sessions. I’m not as worried about messing up, and clients often leave feeling better than when they came. I have realized, however, that as much as I love what I do, I can only manage to work a little bit. I’m functioning much better than I was when I first left hospital, yet I question whether I will be able to work full time again. I’m just too bushed, and therapy, however gratifying, can be draining. Also, between doctors’ appointments, pharmacy and medical lab visits, and all else I do to maintain my health, staying well is a part-time job in itself. I admire people who continue to work despite health challenges, and realize I’m blessed to have someone who will support me if I don’t.

I am surprised by how much being a psychologist defines me, and how unsettling it is to think of losing that identity altogether. Maybe retirement feels like this, except most people have a chance to plan financially and emotionally for that time. I, and many others I’m sure, haven’t had that luxury. It may take me some time yet to get my head around my new reality.

Whether or not I can still legitimately view myself as a psychologist, I plan on celebrating this anniversary. Working or not, I think I’ve earned it. And I’ll take any excuse to eat cake.

Despite the lovely weather in Calgary, J. and I have ventured to rainy Vancouver for a few days. Since I’m not working much right now, how can I justify going on vacation? Sometimes I feel guilty wanting to go away under these circumstances, but the alternatives aren’t great either: I can sit around waiting for the next doctor’s appointment or medical test or trip to the pharmacy or, God forbid, downturn in my health, but why would I? Even though I’m sick and have a lot of time on my hands, I still crave time away from my day-to-day routine. Being somewhere different is a good distraction from cancer. I can forget I’m sick for a few days, and enjoy having time with J.

I try not to let the leukemia consume me when I’m away. If something goes awry, there are always doctors. In fact, the last few vacations, we’ve stayed near English speakers and within close reach of medical care.

When we go, trips are different than they used to be B.C. (before cancer). I helped pay for travel, for one; J. has graciously assumed that responsibility A.D. (after diagnosis). Once we arrived, our days were packed: we’d leave the hotel early and return late. We rarely took transit or taxis, instead walking until we were sore and blistered. On one memorable trip, we had walked so much that on our last day, we had no choice but to lay low all day. We ended up having a fabulous meal in our hotel’s rooftop restaurant overlooking the evening lights of Naples. We would have never stayed in to eat otherwise, but we both remember this night as a highlight of the trip. What a reminder that compromise doesn’t necessarily end in disappointment.

Now that cancer has zapped my energy, we leave the hotel later, return earlier, and often stay in through dinner we cook ourselves. J. has slowed her walking pace considerably so I can keep up, and my afternoon nap is routine. Coffee is my drug of choice only on vacations because, as an occasional imbiber, caffeine makes me uncharacteristically perky.

Oh, and then there’s travel insurance. No chance of my qualifying for that anymore, so we’re on our own if my health turns. But if the choice is between not travelling or taking the risk, we’re willing to take the risk.So far it’s paid off. When I first got sick, unfortunately the weekend of my niece’s Bat Mitzvah, I landed in a Boston emergency room, but I flew back to the Land of Public Health Care before I was hospitalized. On another occasion, I had to hit a walk-in clinic when I somehow neglected to pack my blood thinners (not the kind of medication you want to go without for long). It didn’t take long to convince a doctor I needed the prescription.

So I know well that things can go terribly wrong when I’m away because they have, but I can’t live my life worrying about what could happen. I’ve also learned I can have exciting and unexpected experiences if I take the risk of going away. Any hesitation vanishes when I think of all I’d miss if I just stayed home.

A medical crisis is not without its benefits, not least of which is its highlighting the supports we have around us. When leukemia first landed me in hospital a few years ago, friends cut a trip short to assume care of our two dogs, others offered food, medical consultations, crappy magazines (my favourite kind), words of encouragement, or whatever else they could. And an incredible medical team kept me alive. All this good fortune was noted and appreciated, and J. and I realized how truly blessed we are.

In addition to all these external supports, I had J. I always knew I was blessed with a brilliant, funny, competent, and otherwise incredible spouse. But my leukemia diagnosis brought this truth home. I’ve never known anyone who handles crises as effectively as J. We met 14 years ago, around the time I first got sick, and by the time I was diagnosed with leukemia, J. had long proven herself to be a loyal, caring, and devoted companion. Many times I have encouraged her to trade me in for a younger, healthier model, but she has refused. And trust me, medical issues aside, I am not easy.

J. really outdid herself when I was admitted to hospital with leukemia. She visited me for hours daily, kept abreast of and involved in medical decisions, and advocated for me as necessary. She e-mailed our social network with medical updates and read me their encouraging responses. Once I was discharged from hospital, J. stayed home with me while I recuperated. Initially I did really need her there: my balance and coordination were off, I could not drive, and, because I was so tired and weak, I could barely contribute to the running of the household. Over time, J. felt safe leaving me home on my own, and eventually she returned my car keys. I trusted her judgement because I was not so sure of my own. Most recently, she has willingly assumed the role of primary breadwinner while I remain unable to work full time.

Since I gained my unwanted entry into the Cancer Club, I have met many people who have been in much more challenging situations than me. Some are undergoing more debilitating chemotherapy or radiation, some are divorced or in strained relationships, some are working through treatments to keep food on the table, some have young children who need care and attention. I marvel at these people’s capacity to cope. I’m not sure I could manage their stresses, to be honest, and I realize I am lucky that I don’t have to.

Earlier this year, J. underwent surgery and needed to spend a few days in hospital herself. She was hesitant to do so because she was worried about how I would manage at home on my own. To be honest, I was an absolute mess, which I hid very poorly. (Crying at her hospital bedside is the most blatant example of my failure.) My inability to cope made me marvel all the more at J.’s strength and support through our many years together.

If she hasn’t traded me in yet, I’m probably safe by now, don’t you think?

Well, my visit to the cancer centre yesterday was not quite what I was anticipating. There were high points and there were low points.

Let’s start with the high points, since there were many: 1) the doctor was as close to on time as she has ever been; 2) my chemotherapy has continued to send those cancer cells running for the hills; 3) the pharmacy finally gave me a non-childproof container as per my request since, even as an adult, I can’t master the childproof ones; 4) my great medical team of doctor, nurse, and stellar nurse practitioner gave me the thought, care, and attention I needed; 5) I was at the hospital so long (more later) that I scored not just one but two visits from the Cookie Ladies; and 6) I finally got to taste the tuna sandwich with fresh veggies and hot peppers that J. had been raving about since my long stay in hospital many months ago.

On to the single, unfortunate low point: I have become anemic since last visit and, although J. was noticing some signs, I hadn’t really been aware of much change in my functioning. Since I am chronically exhausted, I find it hard to judge if I am more or less tired than usual on any given day. (On that note, I’ve always been bad at the doctors’ “Rate your pain on a scale of 1 to 10” queries too.) Now that I look back on it, I can see the signs, but I’m not sure I would have noticed the general fog I’ve been in without input from my astute partner and the objectivity of blood testing.

Despite the doctor’s timeliness, then, we ended up spending a very long day at the hospital while I became the grateful recipient of two pints of lovely B+ packed red blood cells. (You blood donors should know how valuable you are to us cancer folk.) Now my leukemia team just has to figure out what’s going on. Unfortunately, a dramatic drop in my red blood count just like this one landed me in hospital when I was first diagnosed with leukemia, so I’ve had to work hard not be agitated by the unexpected news. I will admit to another restless night as I tried, unfortunately between midnight and 3 a.m., to make sense of what had happened.

By now I should know that curve balls are a fact of chronic illness. Things can be going along well…and then they’re not. The key for me is not to get too caught up in these unexpected events–I WILL sleep tonight, if it kills me–and to keep living. So I’m focussed on a planned trip to Vancouver this weekend, and trusting I’ll get the go ahead to be anemic in another province. Really, if anything goes awry, I’ll only be an hour’s flight away. And I imagine they have hospitals in BC too.

Tomorrow I have an appointment with my cancer specialist, my first in three months. I must admit I’d rather hang out somewhere other than the Cancer Centre. Everyone there is extremely nice–there are even Cookie Ladies, gracious volunteers who offer free tea and cookies–but it’s still a hard place to visit. I realize I look quite well relative to many other patients: I have most of my hair, my body is fairly normal, I don’t require a protective mask, but I am pale from anemia. Entering this building is a reminder that I’m on the same team as these patients, that I once looked like them, and may well look like them again in the future.

I was pretty sick when I was first diagnosed with leukemia and was hospitalized for a few months. By the end of my stay, I had lost 20% of my body weight, my belly was markedly distended, and I was jaundiced. Back then I looked like I belonged among my cancer-fighting peers. It took me many months to recover once I was finally discharged and initially my visits to the Cancer Centre were scheduled weekly. Thankfully, my appointments were quickly spaced farther and farther apart.

The medical feedback has been good. My chemotherapy, a small white pill I take every morning, has slowly but surely beaten my cancer cells into submission. CML doesn’t really go into formal remission, but the “bad” cells have been decreasing steadily, to the point where they are becoming hard to find. In fact, in just over a year, I’ve become such a low-priority patient that I am now followed by a highly competent and caring nurse practitioner. I imagine I’ll see the doctor again someday, but there’s some comfort in knowing she feels she can pass me off to someone else.

However infrequent these appointments now are, I always have a bit of trepidation as the date nears. I can’t help but do an internal review of how I’ve been feeling. Have I been more tired or unwell? Are there any other signs my condition has worsened? And how will the doctor interpret my bloodwork? Is my chemotherapy still killing off those nasty cells?

I realize one day the news from the doctor may not be so good. Maybe my chemotherapy will start to lose its effectiveness, or maybe my body will stop tolerating the medication and I’ll have to try something new. But that could be years from now, so I try not to let my mind go there. Sure, I probably won’t sleep all that well tonight–Who am I kidding? Last night wasn’t so restful either!–and I’ll be keyed up until the appointment is over, but I trust all will be fine. If there’s cause for concern, I’ll deal with that when the time comes. For now, I’m just grateful to be well.

I used to go out often on weeknights but I’ve struggled with exhaustion for a long time, and by evening, especially after a long day’s work, I’m bushed. Even now that I’m barely working, I’m pretty tired by afternoon, let alone evening. Naps are almost a daily event, even on a not-especially-productive day. I look back and wonder how I got through the day when I was working full time.

It shouldn’t surprise you, then, that I rarely go out after dinner these days. Friends know not to ask me to join them for evening outings, or, if they do, to expect me to decline. I have adapted to my fatigue by hanging out with the old folks at matinees and meeting friends for lunch or coffee instead of dinner.

Despite my fatigue, especially after dinner, I recently attended an evening class that interested me. Class start time: 6:30 p.m. Yawning start time: 7:30 p.m. When I’m tired, my yawning is persistent, repeated, and wide mouthed. Not the kind you can fight, only to have your efforts not to yawn–the trembling lips, the flaring nostrils–give you away. Yawning isn’t really a problem when I’m going through my day, but it can be disruptive in some settings. Over dinner with friends, for example, or during yoga. (Covering my mouth is hard during certain yoga poses, so not only am I distracting, I’m rude.) We all want to exude good energy, but I’m first to admit I often don’t.

I wasn’t surprised to be tired during this evening class, but my yawning was absolutely relentless. My classmates may not have noticed as much as I had feared, but the teacher certainly did. (Sorry, Lea.)

I feel worst about yawning when I’m with a client. I’ve yawned with clients as long as I’ve battled fatigue–for years–but doing so is awkward and makes me feel awful. How can a client trust I’m engaged and interested and genuinely care about what I’m hearing when I’m yawning through heartfelt disclosures? I’ve made many excuses to clients over the years, such as a bad night’s sleep or an early-awakening dog, but still I worry the client might assume I’m absent. Do my clients ask friends if their psychologist yawns during sessions? I know of a psychiatrist who fell asleep with clients, and that I have never done, so I guess my behaviour could be worse.

If you see a counsellor of some kind, and that counsellor yawns while you’re sharing your soul, please don’t assume he or she is bored or disinterested. I guess the counsellor might be bored (hopefully not!), but it’s more likely her kids didn’t sleep last night, or she watched a great movie into the wee hours, or she ran a marathon on the weekend. Or maybe, like me, she’s sick, but since it’s your hour, she’s not going to talk to you about that. You don’t have to worry about her; just trust she is listening.

If I could dedicate this blog to someone, it would be my friend Scott.

I was diagnosed with chronic myelogenous leukemia (CML) fairly recently, but my introduction to leukemia started many years earlier. In university, I was close friends with a man named Scott. Everyone loved Scott. He was funny and bright and talented and out long before it was cool to be out. Scott was self-confident in public but self-doubting in private like the rest of us. We could talk about anything or not talk at all. Scott and I shared a passion for grocery shopping and he taught me how to get that pesky skin off the garlic by smushing it with the broad side of a knife). We ended up in different cities but remained close, talking often on the phone and visiting when we could. We were so alike, we convinced ourselves we had some late ancestor in common because his great grandmother was Jewish. He was as close as I had ever come to a kindred spirit.

Imagine my shock when Scott called in tears one day to tell me of his diagnosis with lymphoblastic lymphoma, which is similar to acute lymphoblastic leukemia. I supported him as best I knew how at the time, calling him daily, listening, and trying to echo his hope even as things looked grim. Looking back on it, I can’t imagine how scared he must have been, and I’m not sure whether I was a good friend at all. But Scott’s treatments were more invasive and risky then than they would be now, and his just didn’t work. Within four months, at only 32 years old, he had died. I still miss him.

Curiously, the last movie he insisted we see together, long before his diagnosis, was Truly Madly Deeply. If you haven’t seen it, it’s worth finding. This movie is like a better inear nation of Ghost. After a woman’s husband dies, he comes back to help her move through her grief. He and his dead buddies end up annoying her so much in the process that eventually she is glad to be rid of him. The message is the importance of letting go and moving on after the death of a loved one. I think of that movie, and of Scott, often, especially on days that I’m struggling.

So when I was diagnosed with leukemia, I couldn’t help but think of Scott. Yet another way we were cosmically bonded. Were he still here, I would surely call him on my down days, and I imagine he would know just what to say. You may think I am idealizing him, as people often do following a death, but I adored him this much long before he died. I sure hope I told him that.